DOI: 10.1148/rg.262055056
Multi–Detector Row CT of Pancreatic Islet Cell Tumors1
Karen M. Horton, MD,
Ralph H. Hruban, MD,
Charles Yeo, MD and
Elliot K. Fishman, MD
1 From the Russell H. Morgan Department of Radiology and Radiological Sciences (K.M.H., E.K.F.), the Department of Pathology (R.H.H.), and the Department of Surgery (C.Y.), Johns Hopkins Medical Institutions, 601 N Caroline St, JHOC 3253, Baltimore, MD 21287. Presented as an education exhibit at the 2004 RSNA Annual Meeting. Received March 18, 2005; revision requested May 9 and received July 14; accepted July 20. All authors have no financial relationships to disclose.
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Figure 1a. (a) Contrast material–enhanced axial CT scan demonstrates a 1-cm enhancing lesion (arrow) in the pancreatic body. This finding was thought to represent a possible ICT of the pancreas. (b) VR CT angiographic image reveals that the lesion (arrow) is actually a splenic artery aneurysm.
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Figure 1b. (a) Contrast material–enhanced axial CT scan demonstrates a 1-cm enhancing lesion (arrow) in the pancreatic body. This finding was thought to represent a possible ICT of the pancreas. (b) VR CT angiographic image reveals that the lesion (arrow) is actually a splenic artery aneurysm.
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Figure 2. Insulinoma in a 63-year-old woman with hypoglycemia. Contrast-enhanced CT scan demonstrates a 1-cm enhancing lesion (arrow) in the midbody of the pancreas. Robotic laparoscopic enucleation of the lesion was performed. At histologic analysis, a well-differentiated 1.5-cm ICT with a low mitotic rate was seen. The patient’s symptoms resolved after surgery.
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Figure 3. Insulinoma in an 87-year-old man with intractable hypoglycemia. Dual phase CT scan through the pancreas demonstrates a subtle, well-defined 1-cm enhancing lesion (arrow) in the pancreatic neck. A small cyst is also seen. A well-differentiated 1.2-cm ICT was completely excised at surgery. Histologic stains were positive for insulin. The hypoglycemia resolved after surgery.
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Figure 4. Insulinoma in an 84-year-old man who presented with life-threatening hypoglycemia. Contrast-enhanced CT scan demonstrates a 1-cm hyperenhancing lesion (arrow) in the pancreatic neck. A 1.5-cm ICT with no significant mitotic activity was removed at surgery. The lesion was of low malignant potential, being small with circumscribed borders. The patient’s symptoms resolved after surgery.
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Figure 5. Insulinoma in a 46-year-old woman with elevated insulin levels and hyperglycemia. Arterial phase contrast-enhanced CT scan demonstrates a 1.5-cm enhancing mass (arrow) in the pancreatic neck. A 1.5-cm insulinoma was resected at surgery. The lesion had low malignant potential owing to its low mitotic rate, and there was no evidence of invasion of the surrounding tissues.
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Figure 6. Gastrinoma in a 43-year-old patient with MEN 1 who presented with elevated gastrin levels. The patient had a history of nephrolithiasis, hypercalcemia, hyperuricemia, and peptic ulcer disease. Contrast-enhanced CT scan demonstrates a 2-cm exophytic mass (arrow) off the pancreatic tail. The lesion was enucleated laparoscopically. Histologic analysis demonstrated a 3.5-cm ICT. The gastrin levels returned to normal after surgery.
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Figure 7. Gastrinoma in a 62-year-old man with severe peptic ulcer disease and elevated gastrin levels. Contrast-enhanced CT scan demonstrates a subtle, 1-cm enhancing lesion (arrow) in the pancreatic neck. A small ICT was removed at surgery. Histologic analysis showed elevated gastrin markers.
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Figure 8a. Gastrinoma in a 50-year-old man who presented with weight loss and markedly elevated gastrin levels. The patient had MEN 1 with hyperparathyroidism and nephrolithiasis and was thought to have Zollinger-Ellison syndrome. (a) Nonenhanced CT scan shows marked gastric wall thickening. (b) Nonenhanced CT scan reveals a 3–4-cm mass (arrow) in the pancreatic neck. There was no associated pancreatic ductal dilatation. A malignant 5-cm ICT was resected at surgery. Metastatic lymph nodes were also seen.
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Figure 8b. Gastrinoma in a 50-year-old man who presented with weight loss and markedly elevated gastrin levels. The patient had MEN 1 with hyperparathyroidism and nephrolithiasis and was thought to have Zollinger-Ellison syndrome. (a) Nonenhanced CT scan shows marked gastric wall thickening. (b) Nonenhanced CT scan reveals a 3–4-cm mass (arrow) in the pancreatic neck. There was no associated pancreatic ductal dilatation. A malignant 5-cm ICT was resected at surgery. Metastatic lymph nodes were also seen.
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Figure 9. Drawing illustrates the gastrinoma triangle, the area in which gastrinomas most commonly occur.
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Figure 10. Vipoma in a 74-year-old man with watery diarrhea and elevated VIP and PP hormone levels. Contrast-enhanced CT scan demonstrates a large mass with internal septa and calcification in the body and tail of the pancreas. The lesion was resected at surgery. Pathologic analysis revealed a well-differentiated 14.5-cm ICT with soft-tissue invasion and eight nodes, one of which was positive for tumoral involvement. The diarrhea resolved and the VIP and PP hormone levels returned to normal after surgery.
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Figure 11. Duodenal somatostatinoma in a 53-year-old woman with a history of neurofibromatosis who presented with abdominal pain and anemia. The patient had recently experienced a near syncopal episode. Coronal VR CT image demonstrates an enhancing periampullary mass (straight arrow) obstructing the distal common bile duct (curved arrow).
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Figure 12. Nonsyndromic ICT in a 47-year-old patient who presented with abdominal pain. Contrast-enhanced CT scan demonstrates a 2-cm enhancing mass (arrow) in the pancreatic neck. A 2.5-cm ICT was resected at surgery. Minimal angiolytic invasion was noted at histologic analysis.
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Figure 13. Nonsyndromic ICT in a 61-year-old man who presented with abdominal pain. Contrast-enhanced VR CT image demonstrates a 2-cm enhancing mass (arrow) in the pancreatic head and uncinate process. The patient underwent surgery. Postoperative histologic analysis revealed a malignant, well-differentiated 2.3-cm ICT with nodal metastases.
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Figure 14. Nonsyndromic ICT in a 76-year-old man who presented with abdominal pain. Contrast-enhanced VR CT image demonstrates a 10-cm enhancing mass with central necrosis and calcification (arrows) in the pancreatic body and tail. A well-differentiated 12-cm ICT was resected at surgery. No nodal or vascular invasion was noted.
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Figure 15. Nonsyndromic ICT in a 35-year-old man who presented with abdominal pain. Contrast-enhanced CT scan demonstrates a 13 x 8-cm enhancing mass in the pancreatic body. Minimal calcification is present, and encasement of the superior mesenteric and portal veins is also noted. A large ICT was resected at surgery. Vascular invasion was noted at pathologic analysis.
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Figure 16a. Nonsyndromic ICT in a 75-year-old man who presented with abdominal pain. (a) Arterial phase contrast-enhanced CT scan demonstrates enhancing liver metastases. A large hiatal hernia is also noted. (b) Coronal VR CT image shows a 5-cm enhancing mass (arrows) arising from the tail of the pancreas and invading the spleen. A large hiatal hernia and right renal cysts are also seen. Partial pancreatectomy and splenectomy were performed and revealed a pancreatic ICT.
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Figure 16b. Nonsyndromic ICT in a 75-year-old man who presented with abdominal pain. (a) Arterial phase contrast-enhanced CT scan demonstrates enhancing liver metastases. A large hiatal hernia is also noted. (b) Coronal VR CT image shows a 5-cm enhancing mass (arrows) arising from the tail of the pancreas and invading the spleen. A large hiatal hernia and right renal cysts are also seen. Partial pancreatectomy and splenectomy were performed and revealed a pancreatic ICT.
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Figure 17. Nonsyndromic ICT in a 36-year-old man who presented with abdominal pain. Coronal slab VR CT image shows a large mass (arrow) in the left upper quadrant replacing the pancreas and invading the portal vein. Biopsy revealed a pancreatic neuroendocrine tumor.
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Copyright © 2006 by the Radiological Society of North America.
